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Early Botulinum Toxin Injections in Infants With Musculoskeletal Disorders: A Systematic Review of Safety and Effectiveness

  • Jean-Sébastien Bourseul
    Correspondence
    Corresponding author Jean-Sébastien Bourseul, MD, MSc, 2 avenue Foch, CHRU Brest, France 29200.
    Affiliations
    Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France

    Western Brittany University, Brest, France

    Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France
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  • Anais Molina
    Affiliations
    Physical and Rehabilitation Medicine Department, CRMPR Les Herbiers - UGECAM, Bois-Guillaume, France

    University of Rouen-Normandie, Rouen, France
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  • Mael Lintanf
    Affiliations
    Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France

    Western Brittany University, Brest, France
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  • Laetitia Houx
    Affiliations
    Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France

    Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France

    National Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
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  • Emmanuelle Chaléat-Valayer
    Affiliations
    Physical and Rehabilitation Medicine Department, CMCR des Massues Croix-Rouge française, Lyon, France
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  • Christelle Pons
    Affiliations
    Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France

    Western Brittany University, Brest, France

    Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France

    National Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
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  • Sylvain Brochard
    Affiliations
    Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France

    Western Brittany University, Brest, France

    Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France

    National Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
    Search for articles by this author
Published:December 26, 2017DOI:https://doi.org/10.1016/j.apmr.2017.11.013

      Abstract

      Objective

      To report current evidence regarding the safety of intramuscular botulinum toxin injection (BTI) in children with orthopedic- and neurologic-related musculoskeletal disorders >2 years of age.

      Data Sources

      PubMed, Cochrane Library, and ScienceDirect, Google Scholar, and Web of Science.

      Study Selection

      Two reviewers independently selected studies based on predetermined inclusion criteria.

      Data Extraction

      Data relating to the aim were extracted. Methodologic quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale.

      Data Synthesis

      Data of 473 infants were analyzed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot, and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5% to 25%. Results regarding efficacy were preliminary, dependent on the pathology, and limited by the small number of studies and their low levels of evidence.

      Conclusions

      BTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. Regarding effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology.

      Keywords

      List of abbreviations:

      BTI (Botulinum toxin injection), CP (Cerebral palsy), CT (Congenital torticollis), OBPP (Obstetric brachial plexus palsy), PEDro (Physiotherapy Evidence Database), RCT (Randomized controlled trial)
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